Despite Intensifying Conflict in North Kivu, MSF Continues to Provide Health Care

Despite the growing complexity of an already unstable situation in North Kivu, Democratic Republic of Congo (DRC), MSF continues to provide primary and secondary health care to the population, supporting 4 reference hospitals, 12 health centers, 4 health posts, several cholera treatment centers (CTCs), weekly mobile clinics, and emergency response activities as required.

“In the last several weeks, we have seen an increase in cases of malnutrition, respiratory infections, and STIs, in addition to treating or providing support to more than two dozen patients directly wounded from the fighting,” reports Corry Kik, MSF medical coordinator in North Kivu.

Photo: An MSF staff member examines a young patient in Birambizo Health Zone in North Kivu DRC 2012 © Emily Lynch/MSF

MSF Blogs: Yin A Mat Po? (Are You Happy?)

The woman came to us with no living children. She had been pregnant twice before, but both pregnancies resulted in stillbirths. In the first pregnancy, she had labored for days, and the baby died during labor, but delivered vaginally. In the second pregnancy, she had pushed and pushed, but the baby did not deliver. A C-section was done, but the baby died anyway.

I cannot imagine what that must feel like. In the United States, a stillbirth at term is a huge event. Privacy is paramount. A subtle sign is placed on the patient’s door so that the staff knows not to enter unnecessarily. A sympathetic nurse is chosen, one who will comfort the patient. Aggressive pain control is offered, because pain can only make grief worse. And the woman carries that loss with her for the rest of her life.

In South Sudan, it is unusual for a woman not to have lost at least one child. They die in childbirth, or they die later of malnutrition, malaria, infection, unexplained illness. I have seen women who have delivered seven children, only to have three of them die; or delivered four children but having only one living child. When a woman comes to us, the first question asked is “How many children have you had?” The second question is, “How many are alive?”

Read the rest of the blog from Veronica Ades here.

Photo: South Sudan 2012 © Lisa Jones MSF OB-GYN Veronica Ades examines a patient.

Emergency Response Scaled Up as Violence Continues in South Sudan

Tensions and hostilities continue unabated between South Sudan and its northern neighbor Sudan, and MSF is scaling up its emergency response by treating people injured in the latest violence, giving material and staff support to local clinics and hospitals, and providing relief to people displaced by the fighting.

MSF currently provides life-saving surgery in Aweil and Agok for patients wounded in the recent violence. The organization also reinforced its surgical response capacity in case of a general degradation of the situation.

MSF has also donated medicines and medical supplies to local hospitals in Abiemnom and Bentiu in Unity State, both of which have received high numbers of wounded from the recent clashes. Two of MSF’s medical staff have been temporarily seconded to support the Bentiu hospital.

Photo: South Sudan 2012 © Robin Meldrum/MSF Refugees from Blue Nile State in Jamam refugee camp

Libya: A Precarious Situation for Vulnerable Populations

As Libya grapples with consolidating state authority and restoring normality after the revolution, groups of migrants, refugees, and internally displaced people remain in a vulnerable and precarious situation. MSF is continuing to provide basic medical and psychological assistance to these groups in Tripoli. In parallel, MSF will also end its remaining activities in Misrata at the beginning of April to refocus on other areas of intervention.

There are concerns that camps in Tripoli are being shut down by authorities without any clear strategy that the people will be appropriately cared for afterwards, leaving former residents in an even more vulnerable situation. Already on February 14, a camp where hundreds of primarily sub-Saharan African migrants had taken refuge was closed and evacuated. On March 20, another camp housing approximately 300 Somali refugees was evacuated, with residents now being spread out over Tripoli. As MSF had been running mobile clinics in these two camps, it is now trying to trace patients to be able to ensure the provision of follow-up care if needed.

Currently, MSF is running mobile clinics in two camps for internally displaced people in the city, providing basic health care and psychological support. When necessary, MSF also assists in referring residents to secondary health structures. The camps, containing a total of approximately 4,000 people, are primarily made up of people from the Tawargha city. Members of this community were forcibly displaced at the end of the conflict, and are unable to return home. On average, MSF performs 50 consultations in these two camps every week.

Libya 2011 © Niklas Bergstrand
Nearly all buildings in Tripoli street in downtown Misrata were completely destroyed during the war.

“It’s Really a Delicate Balance”: An MSF Doctor in the Jamam Refugee Camp

Dr. Kirrily de Polnay is working with Doctors Without Borders in the Jamam camp in an isolated region of South Sudan, where thousands of refugees from Sudan’s Blue Nile State are currently seeking sanctuary and the coming rainy season threatens to make delivering humanitarian aid even more challenging than it is now. Here, she talks about the situation in Jamam:

“We have so many cases of diarrhea and you’re trying to explain to them how to make the ORS [Oral Rehydration Solution] and they don’t have anything to make it in. Even I can find it hard to judge exactly half a sachet, and you tell them, “whatever you do you must drink water, you must drink the ORS we give you.” And they nod and say yes, but you know that they do not have enough water to really do that. They’ve only got a few liters a day. So what we are prescribing, they don’t have. And so you feel like you are trying to put a tiny plaster on a big hemorrhage.”

Photo:South Sudan 2012 © Robin Meldrum/MSF
MSF doctor Kirrily de Polnay treating a child in the ‘emergency room’ of MSF’s clinic in Jamam refugee camp.

Ethiopia: “There Is Still So Much to Improve”

In early 2011, there were some 40,000 Somali refugees in Ethiopia. By the end of 2011, that number had more than tripled, to 142,000, following a mass exodus triggered by a terrible drought that killed crops and herds in a country already wracked by 20 years of conflict. The numbers alone, however, do not tell much about the days, or even weeks, Somalis spend walking to reach and cross the border with barely any food or water. It does not reveal the dire malnutrition affecting the children in the camps, nor does it express the effort made by humanitarian agencies to fight hunger and exclusion and reduce emergency levels of child mortality. José Luis Dvorzak, an MSF doctor in Liben, reminds us that there is still much work to be done.

You have worked as a doctor at different times in the past two years in the Liben camps.

I first arrived in June 2010. There were three international workers and 35 national employees. We carried out nutritional activities in the two camps, in Bokolmayo and Malkadida (40,000 refugees) and the Dolo Ado health center. The second time I arrived in September 2011, the change had been enormous: we had 50 international workers and over 800 national employees. By then, new camps had been opened, Kobe and Hillaweyn, each sheltering 25,000 new refugees that had arrived from Somalia in the worst of conditions, with very high mortality rates. At one point there had been up to 13,000 people admitted in our feeding program. In September, after months conducting a nutritional intervention, we managed to reduce mortality to levels below the emergency threshold.

How would you describe the medical situation endured by the population at present?

We still have children admitted in our stabilization centers suffering from severe malnutrition complicated with other diseases such as pneumonia or diarrhea—some 45 kids (during the emergency peak this figure rose to over a constant 150) weekly. The most common pathologies amongst the population are respiratory infections, diarrhea, intestinal parasites, and skin diseases. Currently, we are also implementing mental health and epidemiological surveillance programs using community health workers.

Read the rest of the interview with José Luis Dvorzak.

Photo: Ethiopia 2011 © Michael Tsegaye
An MSF staff member uses a feeding tube to treat a malnourished child in Liben’s Hiloweyn camp.

Mali: One Dead and Ten Injured in Attack on Camp

On February 22, a camp of displaced Tuareg civilians were targeted in an airstrike by the Malian armed forces in the north of the country. Teams from the international medical humanitarian organization Doctors Without Borders and the Malian Ministry of Health treated 11 wounded people, 3 of them suffering from grave injuries.

Most of those injured in the airstrike were women and children, including a young girl who died from her injuries. MSF teams and the Malian Ministry of Health provided emergency care and transferred two of the injured to the hospital in Kidal. “We are asking all parties to the conflict to exercise restraint in the use of violence and to distinguish between combatants and civilians,” said Michel Olivier Lacharité, MSF program manager for Mali.

Photo: Mali 2009 © Jean-Michel Van Laere:
The northern Timbuktu region, where MSF ran a measles vaccination campaign in 2009.

Yemen: MSF Responds to the Consequences of Violence in the South

In southern Yemen, where political tensions and clashes continue, Doctors Without Borders is continuously adapting its activities to ensure access to health care for wounded people and life-threatening cases. The organization is involved in two emergency care facilities, organizes the transfer of injured people to Aden, and provides primary care and hospitalization for the population in parts of Aden, Abyan and Lahj governorates.

For more than a year, waves of violence in southern Yemen has caused many injuries and affected the ability of the health care system to cope with needs. In recent months, MSF has provided financial support, human resources and medical supplies to two emergency rooms in the region and a private hospital in Aden in order to offer people in the area access to free-of-charge health care for violence-related medical and surgical emergencies.

The volatile, ever-shifting context requires the organization to constantly redefine where and how to intervene, both in order to get closer to the patients in need and to ensure the safety of medical staff.

Yemen 2010 © Agnes Montanari - An MSF staff member tends to a wounded Yemeni patient.

Lebanon: Healing Those Deeply Affected

Recently, with thousands of Syrians—many of whom have physical wounds—fleeing the violence in their country and seeking refuge in Lebanon, we dispatched medical teams to evaluate their health status. This resulted in our setting up a new health program in Wadi Khaled, in the north of Lebanon, in November 2011. We have been working in Lebanon for three years, and were therefore in a position to closely monitor the health situation for Syrians arriving in the country.

Read more about the work of MSF in Northern Lebanon here.

Photo: Lebanon 2010 © Dina Debbas